Objective: To investigate the effect of size, site, and activity of tympanic membrane (TM) perforation on hearing loss (HL) in Aboriginal and Torres Strait Islander (ATSI) children.Design: Observational study.Methodology: Children aged 5-18 years who identified as ATSI at seven Anangu community schools within the Anangu Pitjantjatjara Yankunytjatjara Lands and Maralinga Lands of South Australia underwent 4-frequency pure-tone audiometry (0.5, 1, 2, and 4 kHz) and video-otoscopy (VO). VO data was reviewed by surgeons for a middle ear diagnosis and VO files with TM perforations were then classified by perforation site (AS, AI, PS, PI, A, P, I) and size (<25%, 25%-50%, 50%-75%, or 75%-100%).Results: Five hundred seventy-five VO files with matching audiological data were obtained. Active perforations (35 dBHL; 28-44 IQR) demonstrated greater HL than inactive perforations (31 dBHL; 29-39 IQR) p = .0029. For inactive perforations there was a significant difference between <25% and all larger perforations (p < .0001) whereas for active perforations the significance changed to between <25% (p < .0001) and 25%-50% (p < .05) when compared to larger perforations.When perforation site was compared within all size/activity groups, no statistically different findings were identified. In all analyses, findings did not change when individual frequencies were compared to 4-frequency pure-tone average dBHL. Conclusion:In ATSI children from remote communities, HL is greater in ears with larger perforations and active middle ear disease but there was no relationship between perforation site and HL.Level of evidence: Level 4. Jack Morris and Zoe Lee are co-first authors.

Objective: To investigate the effect of size, site and activity of tympanic membrane (TM) perforation on hearing loss (HL) in Aboriginal and Torres Strait Islander (ATSI) children. Design: Observational study Methodology: Children aged 5-18 years who identified as ATSI at 7 Anangu community schools within the APY Lands and Maralinga Lands of South Australia underwent 4 frequency pure-tone audiometry (0.5, 1, 2 and 4kHz) and video-otoscopy (VO). VO data was reviewed by surgeons for a middle ear diagnosis and VO files with TM perforations were then classified by perforation site (AS, AI, PS, PI, A, P, I) and size (<25%, 25–50%, 50–75% or 75–100%). Results: 575 VO files with matching audiological data were obtained. Active perforations (35dBHL; 28-44 IQR) demonstrated greater HL than inactive perforations (31dBHL; 29-39 IQR) p=0.0029. For inactive perforations there was a significant difference between <25% and all larger perforations (p<0.0001) whereas for active perforations the significance changed to between <25% (p<0.0001) and 25-50% (p<0.05) when compared to larger perforations. When perforation site was compared within all size/activity groups, no statistically different findings were identified. In all analyses findings did not change when individual frequencies were compared to 4-frequency pure tone average dBHL. Conclusion: In ATSI children from remote communities HL is greater in ears with larger perforations and active middle ear disease but there was no relationship between perforation site and HL.